Spotlight on systemic antimicrobial adjunctive therapy in aggressive periodontitis

In this study, 35 adult patients with untreated aggressive periodontitis were exposed to a microbiological analysis to define the kind of oral microorganisms causing this disease. They were found to harbor sub-gingival Prevotella intermedia, Porphyromonas gingivalis, Capnocytophaga species, Actinobacillus actinomycetemcomitans and Eikenella corrodens as the common putative and anaerobic microorganisms causing the disease. Moreover, a follow up study was carried out on 45 adult patients with untreated aggressive periodontitis. According to the antimicrobial regimens, the patients were treated for 14 days with amoxicillin/clavulanic acid, either alone [group I] or combined with any of certain drugs, including doxycycline 100 mg/day [group II], metronidazole 750 mg/day [group III], doxycycline 100 mg/day and metronidazole 750 mg/day [group IV], doxycycline 20 mg twice daily and metronidazole 750 mg/day [group V]. The study concluded that the systemic administration of the antimicrobial agents as adjunctive therapy of aggressive periodontitis is effective in improving the inflammatory condition. Drug combination therapy is more effective than monotherapy with single agent. The administration of a combination of amoxicillin/clavulanic acid, metronidazole and doxycycline proved an optimum adjunctive drug therapy of periodontitis. The administration of doxycycline in this combination in a sub-antimicrobial dose of 20 mg bid is as effective as doxycycline in a dose of 100 mg/day

Computer-assisted isobolographic analysis of interaction between diclofenac and neostigmine for antinociceptive activity in experimental animals

The main objective of the present study was to evaluate the possible interaction between neostigmine and diclofenac in mice by the acetic acid writhing test. The intraperitoneal administration of neostigmine and diclofenac at different antinociceptive doses allowed to develop dose-response curves for each of them and the calculation of the corresponding ED50s. The interactions of neostigmine with diclofenac were evaluated by isobolographic analysis after the concomitant intraperitoneal administration of both drugs at fixed ratios of their ED50s. The combinations of both drugs were found to be synergistic by isobolographic analysis. The calculation of interaction index alpha as an alternative method to isobolographic analysis of drug interaction gave the same result of synergistic interaction for antinociception between the two drugs when concurrently given

Serum level monitoring of digoxin in cardiac patients attending Assiut University Hospitals: utility in therapy optimizations.

This study addressed the utility of digoxin level monitoring in the optimization of drug therapy. The results revealed toxic serum levels [> ng/ml] only in 91 of the 147 suspected cases. Among 61 patients with inadequate response, low concentrations [<0.7 ng/ml] were noticed. Similarly, in ten patients with non-compliance, very low subtherapeutic levels were observed even to the nil level in 50% of the cases. Accordingly, therapeutic failure of digoxin resulting from under dosage or non-compliance could be detected by TDM that helped in appropriate intervention and in the achievement of optimum clinical outcome. On the other hand, the TDM in clinically controlled cardiac patients indicated that the target concentration of digoxin required to the control heart failure and/or supraventricular arrhythmias could range from 0.7 ng/ml to 2.0 ng/ml. These data indicated that the international therapeutic range [0.7-2.0 ng/ml] of digoxin could be also applied to Upper Egypt cardiac patients. In addition, this study demonstrated the importance of proper sampling time and measurement of serum potassium and creatinine in the interpretation of digoxin level data

Pharmacokinetic basis of intravenous lidocaine administration as 1 mg/kg for assessment of liver condition in patients with liver cirrhosis and/or fibrosis. Part I

The pharmacokinetics of lidocaine administered intravenously as bolus in a dose of 1 mg/kg body weight for assessment of severity of liver disease was evaluated in patients with liver cirrhosis and/or fibrosis [n = 66]compared with healthy volunteers [n = 20]. Two methods of pharmacokinetic analysis were used, two compartment [2C] and model independent[MI] methods. The alteration in lidocaine pharmacokinetics based on MI calculations were more fitting with pathological changes in the liver. In chronic liver diseased patients compared with the control subjects, the elimination half life of lidocaine was significantly prolonged [128 vs 68 minutes, respectively] and clearance was significantly reduced [5.1 vs 10.1 mm/minutes/kg, respectively]. When patients were categorized according to Child-Pugh classification, delay in the elimination of the drug was observed significantly in advanced liver injury [Child B and C groups] compared with Child A. Additionally, liver cirrhosis either alone or when mixed with schistosomal hepatic fibrosis impaired the elimination of lidocaine in a significant way compared with pure schistosomal hepatic fibrosis. Therefore, lidocaine could be used as a marker to evaluate the severity of liver injury based on the study of its disposition in liver diseases

Study of monoethyl glycinexylidide formation in patients with liver cirrhosis either alone or mixed with schistosomal hepatic fibrosis. Part 2

Hepatic function in patients with post-hepatitic cirrhosis either alone [n = 36] or mixed with schistosomal liver fibrosis [n = 30] was assessed based on the formation of lidocaine metabolite, monoethylglycinexylidide [MEGX]. Lidocaine bolus was injected in a dose of 1 mg/kg body weight intravenously and its MEGX metabolite was measured in the serum. The impaired MEGX formation kinetics caused by liver cirrhosis was not pronounced by additional schistosomal liver fibrosis. When patients were stratified according to Child-Pugh classification, MEGX test showed a definite low plasma level in Child C patients distinguishing them from both Child A and B groups. Similar information could be obtained by conventional liver function tests. Although these conventional tests were not enough or specific to discriminate Child B from Child A, MEGX level at 60 minutes could sharply define Child B group form either A or C groups of patients. Therefore, MEGX test could be used as a good and specific marked for assessment of liver function in case of liver cirrhosis which affects definitely its hepatic formation from lidocaine. On the other hand, association of cirrhosis with schistosomal liver fibrosis did not significantly change the formation of MEGX from cirrhosis alone

Disposition and clinical efficacy of methotrexate in patients with rheumatoid arthritis following weekly low intramuscular dosing

In sixteen patients with rheumatoid arthritis [RA], plasma concentrations of methotrexate [MTX] were monitored for 24 hours following the intramuscular [im] dosing with 10 mg per week for at least six weeks. Peak concentrations [0.7 +/- 0.5 mumol/l] were achieved 15 minutes following im injection of the drug, while immeasurable drug levels were observed after 24 hours following its injection. Total body clearance [CL/F] and apparent volume of distribution [V/F] averaged 157 ml/min and 0.64 L/kg, respectively. The elimination half-life was 3.0 +/- 1.1 hours. Clinical assessment of the patients showed less pronounced morning stiffness, improved functional capacity and significant reduction in both articular index score and joint swelling. Nausea was the most common side effect of MTX in this dosage regimen. It was concluded that MTX [10 mg im/week] possess a favorable benefit/risk ratio for the treatment of RA and in such patients the pharmacokinetic parameters are variable but comparable to literature data. There is no relation between the serum level of the drug and its efficacy in RA when administered once weekly

pilot study on disposition and clinical efficacy of methotrexate in patients with rheumatoid arthritis following weekly low intramuscular dosing

In sixteen patients with rheumatoid arthritis [RA], plasma concentrations of methotrexate [MTX] were monitored for 24 hours following the intramuscular [im] dosing with 10 mg per week for at least six weeks. Peak concentrations [0.7 +/- 0.5 mumol/l] were achieved 15 minutes following im injection of the drug, while immeasurable drug levels were observed after 24 hours following its injection. Total body clearance [CL/F] and apparent volume of distribution [V/F] averaged 157 ml/min and 0.64 L/kg, respectively. The elimination half-life was 3.0 +/- 1.1 hours. Clinical assessment of the patients showed less pronounced morning stiffness, improved functional capacity and significant reduction in both articular index score and joint swelling. Nausea was the most common side effect of MTX in this dosage regimen. It was concluded that MTX [10 mg im/week] possess a favorable benefit/risk ratio for the treatment of RA and in such patients the pharmacokinetic parameters are variable but comparable to literature data. There is no relation between the serum level of the drug and its efficacy in RA when administered once weekly